摘要：Introduction Intussusception happens when one part of the intestine invaginates into another adjacent part[1].Transanal protrusion of intussuscep-tion,which is also known as intussusception prolapse,is described as the protrusion of the top of the intussusception from the anus.This presentation accounts for 8％-29％of intussusceptions[2-4].

摘要：Background:Hepatocellular carcinoma(HCC)is one of the most common cancers worldwide and is prevalent in East Asia.Although genome-wide association studies(GWASs)of HCC have identified 23 risk regions,the susceptibility genes underlying these associa-tions largely remain unclear.To identify novel candidate genes for HCC,we conducted liver single-tissue and cross-tissue transcrip-tome-wide association studies(TWASs)in two populations of East Asia. Methods:GWAS summary statistics of 2,514 subjects(1,161 HCC cases and 1,353 controls)from the Chinese Qidong cohort and 161,323 subjects(2,122 HCC cases and 159,201 controls)from the BioBank Japan project were used to conduct TWAS analysis.The single-tissue and cross-tissue TWAS approaches were both used to detect the association between susceptible genes and the risk of HCC.TWAS identified genes were further annotated by Metascape,UALCAN,GEPIA2,and DepMap. Results:We identified 22 novel genes at 16 independent loci significantly associated with HCC risk after Bonferroni correction.Of these,13 genes were located in novel regions.Besides,we found 83 genes overlapped in the Chinese and Japanese cohorts with P<0.05,of which,three genes(NUAK2,HLA-DQA1,and ATP6V1G2)were discerned by both single-tissue and cross-tissue TWAS approaches.Among the genes identified through TWAS,a significant proportion of them exhibit a credible role in HCC biology,such as FAM96B,HSPA5,POLRMT,MPHOSPH10,and RABL2A.HLA-DQA1,NUAK2,and HSPA5 associated with the process of carcinogenesis in HCC as previously reported. Conclusions:Our findings highlight the value of leveraging the gene expression data to identify new candidate genes beyond the GWAS associations and could further provide a genetic insight for the biology of HCC.

摘要：Background:Standardized assessments of clinical complete response(cCR)to neoadjuvant chemoradiotherapy(nCRT)for rectal cancer have been established,but their utility and accuracy remain unclear.This study aimed to evaluate the clinical diagnostic value of rectal magnetic resonance imaging(MRI)and endorectal ultrasonography(ERUS)for the determination of cCRs after neoadjuvant immunotherapy and to investigate the concordance between cCR and pathological complete response(pCR). Methods:Ninety-four patients with rectal cancer treated with neoadjuvant radiotherapy with or without immunotherapy were included.The sensitivity,specificity,and accuracy of each evaluation method were calculated. Results:Combined MRI and ERUS assessments found cCR in seven of the 94 patients in our cohort.In the non-immunotherapy group,the sensitivity,specificity,and accuracy of MRI for diagnosing cCR were 50.0%,85.2%,and 77.1%,respectively,whereas those of ERUS were 50.0%,92.6%,and 82.9%,respectively;those of combined MRI and ERUS were 25.0%,96.3%,and 87.5%,respectively.In the immunotherapy group,the sensitivity,specificity,and accuracy with which MRI identified CR were 51.7%,76.7%,and 64.4%,respectively;those of ERUS were 13.8%,90.0%,and 52.5%,respectively,and those of combined MRI and ERUS were 10.3%,96.7%,and 54.2%,respectively.We also found that 32 of 37 patients with pCR did not meet the cCR evaluation criteria.Of these pCR patients,78.4%(29/37)received immunotherapy.In the entire cohort,there were five pCRs among the seven cCRs.Of the four cCRs that occurred in the immunotherapy group,three were pCRs. Conclusions:Rectal MRI and/or ERUS did not provide sufficiently accurate assessments of cCR in patients with rectal cancer receiving neoadjuvant therapy,especially immunotherapy,and cCR did not predict pCR.

摘要：Background:Gastroesophageal reflux disease(GERD)is heterogeneous with a varied symptom spectrum and reflux profiles.Its defi-nite diagnosis often requires invasive tools including endoscopy or reflux monitoring.The aim of this study was to investigate the clinical relevance of salivary pepsin detection as a non-invasive screening tool to diagnose GERD of different subtypes. Methods:A total of 77 patients with suspected GERD symptoms and 12 asymptomatic controls were analysed.All participants per-formed symptom evaluation,upper endoscopy,esophageal manometry,and 24-hour multichannel intraluminal impedance-dual pH probe monitoring.Saliva was self-collected across three different time points:at early fasting,postprandially,and at symptom occur-rence.Salivary pepsin levels were measured via Peptest.The optimal threshold of salivary pepsin for diagnosing distal or proximal reflux was determined according to a receiver-operating characteristic curve. Results:The average salivary pepsin concentration of suspected GERD patients was significantly higher than that of controls(100.63[68.46,141.38]vs 67.90[31.60,115.06]ng/mL,P=0.044),although no difference was found among patients with different symptom spectrums.The distal reflux group had a higher average pepsin concentration than non-reflux patients(170.54[106.31,262.76]vs 91.13[63.35,127.63]ng/mL,P=0.043),while no difference was observed between the distal reflux group and the proximal reflux group.The optimal cut-off value of salivary pepsin concentration for diagnosing pathological distal reflux was 157.10 ng/mL,which was higher than that for diagnosing pathological proximal reflux(122.65 ng/mL).The salivary pepsin concentration was significantly correlated with distal and proximal reflux parameters. Conclusions:Salivary pepsin measurement can help in identifying true GERD with pathological distal reflux or proximal reflux,re-gardless of different symptom spectrums.A higher threshold should be applied for diagnosing distal reflux than for proximal reflux.

摘要：Background:Accurate preoperative evaluation of fistula-in-ano can guide the choice of surgical procedure and may improve healing rates.This prospective study aimed to evaluate the accuracy of conventional 3D transperineal ultrasound(3D-TPUS)compared with SonoVue(SVE)-enhanced 3D-TPUS for the detection and classification of anal fistula. Methods:In this prospective study,3D-TPUS reconstructions were performed before and after SVE enhancement in 60 patients with fistula-in-ano who intended to undergo surgery at the Department of Anorectal Surgery,Qilu Hospital,Cheeloo College of Medicine,Shandong University(P.R.China)between January 2021 and October 2021.Accuracies of anal fistula classification,complexity classi-fication,detection of anal fistula branches,and detection of internal opening between 3D-TPUS and SVE 3D-TPUS were compared based on a reference standard—intraoperative findings. Results:This study enrolled 60 patients(mean age,37.1±11.4 years;mean follow-up,9±3 months).Intraoperative findings showed that the fistula type was intersphincteric in 23 patients(38.3%),trans-sphincteric in 35(58.3%;12 high and 23 low),and suprasphinc-teric in 2(3.3%).Moreover,68 internal openings were found.Compared with the accuracy of 3D-TPUS,that of SVE 3D-TPUS was simi-lar in fistula classification[95.0%(57/60)vs 96.7%(58/60),P=0.392],but significantly higher in internal opening evaluation[80.9%(55/68)vs 97.1%(66/68),P=0.001],complexity classification[85.0%(51/60)vs 98.3%(59/60),P=0.018],and detection of fistula branches[70.4%(19/27)vs 92.6%(25/27),P=0.031]. Conclusions:SVE 3D-TPUS may be a useful examination for patients with perianal fistulae because of its high accuracy and consis-tency with intraoperative findings,especially in complex fistula-in-ano and difficult cases.

摘要：Background:Autophagy death of cancer cells is detrimental to apoptosis induced by therapeutic drugs,which promotes tumor pro-gression to a certain extent.Increasing reports have demonstrated the regulatory role of circular RNAs(circRNAs)in autophagy.Here,we aimed to determine the role of hsa_circ_0009109 in autophagy in gastric cancer(GC). Methods:The effects of hsa_circ_0009109 on autophagy were examined using quantitative real-time polymerase chain reaction(qPCR),transmission electron microscopy,Western blot,and immunofluorescence.The mechanism of hsa_circ_0009109 regulating the miR-544a-3p/bcl-2 axis was analysed using fluorescence in situ hybridization,dual-luciferase reporter,and rescue experiments. Results:Functional testing indicated that hsa_circ_0009109 was significantly down-expressed in GC tissues and cell lines.A reduc-tion in cytoplasmic-derived hsa_circ_0009109 could promote GC progression by accelerating cell proliferation,enhancing migration and invasion,inhibiting apoptosis,and accelerating the cell cycle progression.Besides,hsa_circ_0009109 was found to exert the ef-fect of an autophagy inhibitor such as 3-Methyladenine(3-MA),which was manifested by the weakening of the immunofluorescence of LC3B and the reduction in autophagy-related proteins after overexpression of hsa_circ_0009109,while increased autophagosomes were observed after interference with hsa_circ_0009109.Subsequently,the crosstalk between hsa_circ_0009109 and miR-544a-3p/bcl-2 was verified using dual-luciferase reporter assay.The autophagy status was altered under the regulation of the hsa_circ_0009109-targeted miR-544a-3p/bcl-2 axis. Conclusions:The hsa_circ_0009109 mediated a novel autophagy regulatory network through targeting the miR-544a-3p/bcl-2 axis,which may shed new light on the exploration of therapeutic targets for the clinical treatment of GC.

摘要：Background:Chronic hepatitis B(CHB)significantly impacts the health-related quality of life(HRQoL),but remains underexplored in the Thai population.Health state utilities(HSU)are indicators reflecting HRQoL which serve as fundamental inputs for economic evaluation analyses.This study aimed at assessing differences in HRQoL across five CHB stages in Thai patients,including non-cirrhotic CHB,compensated cirrhosis,decompensated cirrhosis,early-/intermediate-stage hepatocellular carcinoma(HCC)and ad-vanced-/terminal-stage HCC. Methods:We conducted a cross-sectional study to collect HRQoL data from patients with CHB at five stages.The study included patients with CHB who were followed up at a super-tertiary care centre between March 2021 and February 2022.The participants completed the EQ-5D-5L questionnaire and provided demographic data.Disease stage and relevant data were obtained from medical records.HSU and Euroqol-visual analogue scale(EQ-VAS)scores,calculated using Thai-specific conversion coefficients,were assessed. Results:Among 422 patients,236 did not have cirrhosis,92 had compensated cirrhosis,13 had decompensated cirrhosis,55 had early-/intermediate-stage HCC,and 26 had advanced-/terminal-stage HCC.The HSU scores for non-cirrhotic,compensated cirrhosis,decompensated cirrhosis,early-/intermediate-stage HCC and advanced-/terminal-stage HCC were 0.95±0.08,0.89±0.16,0.79±0.19,0.89±0.12 and 0.52±0.39,respectively.Similarly,the EQ-VAS scores for various CHB stages were 83.56±12.90,80.48±13.03,68.76±17.40,79.00±14.38 and 62.92±20.62,respectively.A significant correlation(r=0.469,P<0.001)was observed between the HSU and EQ-VAS scores.The disease progression led to a notable HSU decline,particularly in the advanced-/terminal-stage HCC group(re-gression coefficient:-0.436,P<0.001).The EQ-VAS scores indicated reduced quality of life in advanced liver disease. Conclusions:Later CHB stages compromise the HRQoL.Decompensated cirrhosis and advanced-/terminal-stage HCC profoundly af-fect physical health and quality of life,whereas patients with compensated cirrhosis and early-/intermediate-stage HCC report better HRQoL.

摘要：Background:Since boosting stem cell resilience in stressful environments is critical for the therapeutic efficacy of stem cell-based transplantations in liver disease,this study aimed to establish the efficacy of a transient plasmid-based preconditioning strategy for boosting the capability of mesenchymal stromal cells(MSCs)for anti-inflammation/antioxidant defenses and paracrine actions in re-cipient hepatocytes. Methods:Human adipose mesenchymal stem cells(hADMSCs)were subjected to transfer,either with or without the nuclear factor erythroid 2-related factor 2(Nrf2)/Dickkopf1(DKK1)genes,followed by exposure to TNF-α/H2O2.Mouse models were subjected to acute chronic liver failure(ACLF)and subsequently injected with either transfected or untransfected MSCs.These hADMSCs and ACLF mouse models were used to investigate the interaction between Nrf2/DKK1 and the hepatocyte receptor cytoskeleton-associated protein 4(CKAP4). Results:Activation of Nrf2 and DKK1 enhanced the anti-stress capacity of MSCs in vitro.In a murine model of ACLF,transient co-overexpression of Nrf2 and DKK1 via plasmid transfection improved MSC resilience against inflammatory and oxidative assaults,boosted MSC transplantation efficacy,and promoted recipient liver regeneration due to a shift from the activation of the anti-regenerative IFN-γ/STAT1 pathway to the pro-regenerative IL-6/STAT3 pathway in the liver.Importantly,the therapeutic benefits of MSC transplantation were nullified when the receptor CKAP4,which interacts with DKK1,was specifically removed from recipient hepatocytes.However,the removal of the another receptor low-density lipoprotein receptor-related protein 6(LRP6)had no impact on the effectiveness of MSC transplantation.Moreover,in long-term observations,no tumorigenicity was detected in mice following transplantation of transiently preconditioned MSCs. Conclusions:Co-stimulation with Nrf2/DKK1 safely improved the efficacy of human MSC-based therapies in murine models of ACLF through CKAP4-dependent paracrine mechanisms.

摘要：Gastroesophageal reflux disease(GERD)is a widely prevalent gastrointestinal disorder,affecting～13.3%of the global population.There are shortages and limitations of current GERD treatment modalities,and complementary and alternative therapy(CAT)is a promising option to fill in the gap.Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms.Traditional Chinese medicine and brain-gut behavior therapy,particularly transcutaneous electrical acustimula-tion and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD.CAT may help to relieve GERD symptoms,minimize medication dosage,and slow the demand for surgery.The aim of this review was to summarize the exist-ing evidence of some common CATs in treating symptomatic GERD,including dietary modification,lifestyle change,traditional Chinese medicine,and brain-gut behavior therapy.

摘要：Gastrointestinal cancers have become an important cause of cancer-related death in humans.Improving the early diagnosis rate of gastrointestinal tumors and improving the effect of surgical treatment can significantly improve the survival rate of patients.The conventional diagnostic method is high-definition white-light endoscopy,which often leads to missed diagnosis.For surgical treatment,intraoperative tumor localization and post-operative anastomotic state evaluation play important roles in the effect of surgical treatment.As a new imaging method,near-infrared fluorescence imaging(NIRFI)has its unique advantages in the diagnosis and auxiliary surgical treatment of gastrointestinal tumors due to its high sensitivity and the ability to image deep tissues.In this review,we focus on the latest advances of NIRFI technology applied in early diagnosis of gastrointestinal tumors,identification of tumor margins,identification of lymph nodes,and assessment of anastomotic leakage.In addition,we summarize the advances of NIRFI systems such as macro imaging and micro imaging systems,and also clearly describe the application process of NIRFI from system to clinical application,and look into the prospect of NIRFI applied in the theranostics of gastrointestinal tumors.

摘要：Introduction The ABCB11 gene encodes for the bile salt export pump(BSEP)—the main exporter of bile acids expressed on the canalicular membrane of the hepatocyte[1-3].Pathogenic variants in the ABCB11 gene can lead to a range of clinical conditions.These conditions vary from benign recurrent intrahepatic cholestasis type 2(BRIC2),which is a non-severe disorder characterized by occasional episodes of low levels of gamma-glutamyl transferase(GGT)cholestasis,to progressive familial intrahepatic cholestasis type 2(PFIC2),which is more severe and may necessitate liver transplantation.

摘要：Background:Small bowel involvement is related to poor prognosis in Crohn's disease(CD),which may be a potential marker to strat-ify patients with a high risk of progression.This study aimed to establish a novel location classification system for CD and to develop a predictive model for disease progression. Methods:Consecutive patients with non-stricturing/non-penetrating CD were retrospectively included in the Sixth Affiliated Hospital,Sun Yat-sen University(Guangzhou,P.R.China)between January 2012 and January 2018.Patients were classified into two groups according to disease location:small bowel involvement group and isolated colon group.The primary outcome was disease progression to stricturing or penetrating phenotypes.Progression-free survival was estimated using Cox proportional hazards regres-sion analysis and Kaplan-Meier method. Results:A total of 463 patients were analysed,with a median follow-up time of 55.3 months.Patients with small bowel involvement had a higher risk of disease progression than those with isolated colon disease(hazard ratio=1.998,P=0.007),while no differences were found between Montreal location classification and disease progression.Median progression-free survival was higher in the iso-lated colon group than in the small bowel involvement group(84.5 vs 77.3 months,P=0.006).Four independent factors associated with disease progression were identified:small bowel involvement,duration of onset of>1 year,deep mucosal ulcer,and C-reactive protein levels of≥10 mg/L(all P<0.05).The nomogram model based on these factors showed good performance in predicting disease progression,with a C-index of 0.746(95%confidence interval,0.707-0.785). Conclusions:Classifying CD based on small bowel involvement and isolated colon was superior to the Montreal location classifica-tion for predicting disease progression.

摘要：Introduction In contrast to familiar developmental anomalies,such as pan-creatobiliary maljunction and pancreas divisum,a double orifice of the ampulla of Vater is a much more rare congenital malfor-mation.We encountered a patient with pancreatolithiasis associ-ated with anatomic variation of Wirsung duct showing a single major duodenal papilla with a double orifice and no mi-nor papilla.

摘要：Background:Acute kidney injury(AKI)is a serious adverse event often overlooked following major abdominal surgery.While radical gastrectomy stands as the primary curative method for treating gastric cancer patients,little information exists regarding AKI post-surgery.Hence,this study aimed to ascertain the incidence rate,risk factors,and consequences of AKI among patients undergoing radical gastrectomy. Methods:This was a population-based,retrospective cohort study.The incidence of AKI was calculated.Multivariate logistic regres-sion was used to identify independent predictors of AKI.Survival curves were plotted by using the Kaplan-Meier method and differ-ences in survival rates between groups were analyzed by using the log-rank test. Results:Of the 2,875 patients enrolled in this study,61(2.1%)developed postoperative AKI,with AKI Network 1,2,and 3 in 50(82.0%),6(9.8%),and 5(8.2%),respectively.Of these,49 patients had fully recovered by discharge.Risk factors for AKI after radical gastrec-tomy were preoperative hypertension(odds ratio[OR],1.877;95%CI,1.064-3.311;P¼0.030),intraoperative blood loss(OR,1.001;95%CI,1.000-1.002;P¼0.023),operation time(OR,1.303;95%CI,1.030-1.649;P¼0.027),and postoperative intensive care unit(ICU)admis-sion(OR,4.303;95%CI,2.301-8.045;P<0.001).The probability of postoperative complications,mortality during hospitalization,and length of stay in patients with AKI after surgery were significantly higher than those in patients without AKI.There was no statistical difference in overall survival(OS)rates between patients with AKI and without AKI(1-year,3-year,5-year overall survival rates of patients with AKI and without AKI were 93.3%vs 92.0%,70.9%vs 73.6%,and 57.1%vs 67.1%,respectively,P¼0.137). Conclusions:AKI following radical gastrectomy is relatively rare and typically self-limited.AKI is linked with preoperative hyperten-sion,intraoperative blood loss,operation time,and postoperative ICU admission.While AKI raises the likelihood of postoperative complications,it does not affect OS.

摘要：Wu et al.[1]recently published a study on potential prognostic and therapeutic values of immune cell infiltration(ICI)subtypes in colorectal cancer(CRC).In this study,they creatively designed a new approach combining the CIBERSORT and ESTIMATE meth-ods to assess the differences in the intra-tumor immune infiltra-tion landscape of CRC samples and its association with prognosis.

摘要：Background:The immune microenvironment(IME)is closely associated with prognosis and therapeutic response of hepatitis B virus-related hepatocellular carcinoma(HBV-HCC).Multi-parametric magnetic resonance imaging(MRI)enables non-invasive as-sessment of IME and predicts prognosis in HBV-HCC.We aimed to construct an MRI prediction model of the immunocyte-infiltration subtypes and explore its prognostic significance. Methods:HBV-HCC patients at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)with radical surgery(be-tween 1 October and 30 December 2021)were prospectively enrolled.Patients with pathologically proven HCC(between 1 December 2013 and 30 October 2019)were retrospectively enrolled.Pearson correlation analysis was used to examine the relationship between the immunocyte-infiltration counts and MRI parameters.An MRI prediction model of immunocyte-infiltration subtypes was con-structed in prospective cohort.Kaplan-Meier survival analysis was used to analyse its prognostic significance in the retrospec-tive cohort. Results:Twenty-four patients were prospectively enrolled to construct the MRI prediction model.Eighty-nine patients were retro-spectively enrolled to determine its prognostic significance.MRI parameters(relative enhancement,ratio of the apparent diffusion coefficient value of tumoral region to peritumoral region[rADC],T1 value)correlated significantly with the immunocyte-infiltration counts(leukocytes,T help cells,PD1+Tc cells,B lymphocytes).rADC differed significantly between high and low immunocyte-infiltration groups(1.47±0.36 vs 1.09±0.25,P=0.009).The area under the curve of the MRI model was 0.787(95%confidence interval 0.587-0.987).Based on the MRI model,the recurrence-free time was longer in the high immunocyte-infiltration group than in the low immunocyte-infiltration group(P=0.026). Conclusions:MRI is a non-invasive method for assessing the IME and immunocyte-infiltration subtypes,and predicting prognosis in post-operative HBV-HCC patients.

摘要：Introduction Artificial intelligence(AI)is a concept that commonly refers to machines mimicking human cognitive behavior during learning and problem-solving[1].Chatbots are a typical example of an AI system,capable of interacting with humans[2].ChatGPT(OpenAI,San Francisco,CA,USA)[3]is a new-generation chatbot that captures the context and relationship between words in in-put sequences through multiple layers of self-attention and feed-forward neural networks.Then,it predicts the most likely"token"to succeed the previous one based on patterns in its training data.Therefore,it is a self-contained system that does not copy existing information[4].

摘要：Background:Recent studies have found that thyroid function may be associated with the occurrence and development of advanced liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease(MAFLD).However,the majority of such research has consisted of cross-sectional studies.This retrospective cohort study aimed to investigate the effect of low-normal thyroid function on advanced liver fibrosis in MAFLD patients over a 5-year period. Methods:This retrospective cohort study enrolled 825 outpatients and inpatients with MAFLD who attended the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2011 and December 2018.Based on plasma thyroid hormone and thyroid-stimulating hormone levels,these patients were divided into two groups,namely a low-normal thyroid function group and a strict-normal thyroid function group.The fibrosis-4 score was used to assess advanced liver fibrosis.A chi-square test was conducted to compare the occurrence of advanced fibrosis between the groups. Results:Among the 825 MAFLD patients,117 and 708 were defined as having low-normal thyroid function and strict-normal thyroid function,respectively.Follow-up data were available for 767 patients(93.0%)during a 5-year period.Eight(7.5%)MAFLD patients with low-normal thyroid function and 26(3.9%)with strict-normal thyroid function developed advanced liver fibrosis and the cumulative incidence was not significantly different(P=0.163).Stratification analysis showed that the lean MAFLD patients(body mass index≤23 kg/m2)with low-normal thyroid function had a higher risk of advanced liver fibrosis than the lean MAFLD patients with strict-normal thyroid function(P<0.05). Conclusion:Low-normal thyroid function is associated with advanced liver fibrosis among lean MAFLD patients.

摘要：Background:Metastasis is the main cause of death in colorectal cancer(CRC).Metastasis is a sequential and dynamic process,but the development of tumor cells during this process is unclear.In this study,we aimed to reveal characteristics of tumor cell subset during CRC metastasis. Methods:Single-cell RNA sequence CRC data of normal epithelium,non-metastatic primary tumor,metastatic primary tumor,and liver metastases from gene expression omnibus(GEO)dataset were analyzed to reveal characteristics of CRC metastasis.Primary tu-mor tissues of three non-metastatic CRC and three metastatic CRC patients from Union Hospital of Tongji Medical College(Wuhan,China)were used to verify the characteristics of CRC metastasis. Results:We identified a metastasis-related cancer cell subset EP1,which was characterized with a high expression of KRT17,LAMC2,EMP1,and PLAC8.EP1 had an enhanced cell-cell interaction,which interacted with SPPþ macrophages and drove them toward anti-inflammatory and immunosuppressive phenotype.Dynamic changes in genes and TF regulons during the metastasis were also revealed. Conclusions:This study advanced our understanding of the development of tumor cells during CRC metastasis and further identi-fied metastasis-related subset and potential therapeutic targets for the treatment and prevention of CRC metastasis.

摘要：Background:Since the introduction of direct-acting antivirals,thousands of chronic hepatitis C patients have been successfully treated.However,vulnerable populations have a higher prevalence of hepatitis C virus(HCV)infection and face barriers that impede their access to antivirals.We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. Methods:People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included.After providing participants with educational information on HCV,a dry drop test(DDT)was used to collect blood for subsequent screening for HCV infection.The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments,including blood tests,ultrasonography,elastography,and the prescription of antivirals,all conducted in a single hospital visit.Sustained viral response(SVR)was analysed 12 weeks after end of treatment. Results:Of the 417 persons invited to participate,271(65％)agreed to participate in the program.These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection(10％).These hepatitis C-infected patients had a mean age of 53±9 years;86％were males and 93％were or had been drug users.Among 23 patients with HCV infection,HCV genotype 1a predomi-nated(74％).Medical exams showed that 19％(4/21)had advanced fibrosis(F3-4),and 5％(1/21)had portal hypertension.Finally,23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients(96％). Conclusions:Drug users and homeless people have a higher prevalence of HCV infection than the general population.The microeli-mination program with educational activity and screening tools achieved a high participation rate,easy healthcare access,and a high rate of SVR despite the SARS-CoV-2 pandemic.